Treatment of refractory amblyopia with levodopa associated with full-time occlusion in the dominant eye / Tratamento da ambliopia refratária com o uso de levodopa associada à oclusão total do olho dominante

Abstract Purpose: To evaluate visual outcomes of levodopa treatment associated with full occlusion of the dominant eye in patients with refractory amblyopia. Methods: A prospective study of 19 attended patients who were subject to treatment with Levodopa and Carbidopa on doses of 0.7mg/kg/day, a ratio of 4:1 divided into three daily doses for 5 weeks, combined with full occlusion (24 hours/day) of the dominant eye. The ophthalmologic exam from previous consultations up to treatment and after 8 weeks of therapy were collected from medical record data. Patients who had completed treatment for more than 12 months were included for complete eye examination. Results: The mean age before treatment with levodopa was 11.0 ± 4.2 years old (varying from 7 to 23 years). The best-corrected visual acuity (Snellen chart) of the amblyopic eye before treatment was 0.24 (0.6 in logMAR) ± 0.16, after 8 weeks of treatment it was 0.47(0.3 in logMAR) ± 0.33, while during the final evaluation it was 0.46 (0.3 in logMAR) ± 0.34. There was a statistically significant improvement in vision after 8 weeks of therapy which was maintained until the final evaluation (p = 0.007). Conclusion: Levodopa/Carbidopa therapyat doses of 0.7 mg/kg/day at a ratio of 4:1 divided in three daily doses, associated with full occlusion of the dominant eye during 5 weeks had a significant improvement on the visual acuity of the amblyopic eye, and persisted up to 1 year after the treatment.

Resumo Objetivo: Avaliar os resultados visuais do tratamento com levodopa associada à oclusão total do olho dominante em pacientes amblíopes. Métodos: Estudo prospectivo de 19 pacientes atendidos e submetidos ao tratamento com levodopa e carbidopa na dose de 0,7 mg/kg/dia e proporção de 4:1, divididos em três doses diárias, durante cinco semanas, combinada a oclusão total (24 horas/dia) do olho dominante. Foram coletados dados do prontuário referentes ao exame oftalmológico da consulta anterior ao tratamento e após 8 semanas de terapia. Os pacientes com término do tratamento com mais de 12 meses foram reconvocados para exame oftalmológico completo. Resultados: A média de idade dos pacientes previamente ao tratamento com levodopa foi de 11,0 ± 4,2 anos (variando de 7 a 23 anos). A acuidade visual melhor corrigida (Snellen) do olho amblíope antes do tratamento foi de 0,24 (0,6 em logMAR) ± 0,16, após 8 semanas de tratamento foi de 0,47 (0,3 em logMAR) ± 0,33 e na avaliação final foi de 0,46 (0,3 em logMAR) ± 0,34. Houve melhora estatisticamente significante da visão após 8 semanas de tratamento que se manteve até a avaliação final (p = 0,007) Conclusão: A terapia com levodopa/carbidopa em doses de 0,7mg/kg/dia na proporção de 4:1 dividida em três doses diárias, associada à oclusão total do olho dominante durante 5 semanas, apresentou uma melhora significativa na acuidade visual do olho ambliópico e persistiu até 1 ano após o tratamento.

Current Management of Childhood Amblyopia

Amblyopia is defined as the reduction of best-corrected visual acuity of one or both eyes caused by conditions that affect normal visual development. The basic strategy to treat amblyopia is to obtain a clear retinal image in each eye and correct ocular dominance through forced use of the amblyopic eye. Treatment modalities include correcting any underlying organic disease, prescribing appropriate optical correction, and providing occlusion/penalization therapy for the non-amblyopic eye. Given the success of amblyopia treatment declines with increasing age, the detection and management of amblyopia should begin as early as possible during the sensitive period for visual development. Proper management of amblyopia during childhood can reduce the overall prevalence and severity of visual loss. This study aims to provide an update for the management of childhood amblyopia to provide better visual outcomes.

Relationship between Dominant Eye and Refractive Error in Myopic Anisometropia

PURPOSE: To investigate the relationship between dominant eye and refractive error in patients with myopic anisometropia. METHODS: This study population consisted of myopes less than 15 years old who were followed up for anisometropia defined as interocular difference of spherical equivalent (SE) ≥1.0 diopter (D). All patients underwent the hole-in-the-card test at far and near to determine ocular dominance. The data were analyzed for statistical significance using Fisher's exact test. RESULTS: A total of 102 eyes in 51 patients were analyzed. The mean age of the patients was 10.4 ± 1.4 years and 54.9% were male. The mean SE was −2.97 ± 1.95 D in the right eye and −3.02 ± 1.92 D in the left eye. The right eye was the dominant eye in 43.1% and 37.3% at distance and near, respectively. The agreement of dominancy between distant and near was 82.4%. The near dominant eyes showed statistically significant accordance with more myopic eyes (p = 0.009). On the other hand, there was no statistically significant relationship between more myopic eyes and distant dominant eyes (p = 0.09). CONCLUSIONS: The near dominant eye was more myopic eye in patients with myopic anisometropia. This was considered to be related with the lag of accommodation in dominant eye with near distance.

The Analysis of Ocular Deviations between Dominant and Non-dominant Eye Using Video-oculography in Intermittent Exotropia

PURPOSE: To measure and analyze ocular deviations between dominant and non-dominant eyes using video-oculography (VOG) in intermittent exotropia. METHODS: Fourteen subjects who were diagnosed with intermittent exotropia from July 2017 to July 2018 with age of 5 or more, visual acuity of 20/30 or better and corrected visual acuity of 20/25 or more and difference in vision of both eyes of 1 line or less on Snellen optotype were included. The subjects were asked to fixate on a black-on-white optotype at 1 m, which subtended a visual angle of 50 minutes of arc. The video files and data about ocular deviations were obtained using VOG with alternate cover test. We analyzed angles of ocular deviations in dominant and non-dominant eyes. RESULTS: Among the 14 subjects in this study, the mean age were 7.6 ± 1.7 (range 5–9 years). Seven of 14 subjects had the right eye dominance. Six of the 14 subjects were men. There was no significant difference of ocular deviations between the dominant and non-dominant eyes in VOG (p = 0.167). Additionally, there was no significant difference of the values of VOG when one eye was exodeviated or re-fixated (p = 0.244), when both eyes were deviated, and when both eyes were re-fixated (p = 0.195, 0.637). CONCLUSIONS: In this study, there was no significant difference of ocular deviations between the dominant and non-dominant eyes, between when an eye was exodeviated or fixated using VOG. Therefore, it may not be a problem even if alternate prism cover test is performed in any eye in intermittent exotropia of more than 50 prism diopter without amblyopia or refraction abnormality that could affect the uncorrected visual acuity.

Clinical Study of Changes in Eye Dominance after Pseudophakic Conventional Monovision

PURPOSE: The purpose of this study was to evaluate whether eye dominance changes after conventional pseudophakic monovision, and to identify factors that affect changes in eye dominance. METHODS: This retrospective study included 70 patients who underwent bilateral conventional monovision cataract surgery. Patients were divided into two groups based on whether they experienced a change in the dominant eye. We compared patients' uncorrected distance visual acuity (UCDVA), uncorrected near visual acuity (UCNVA), best-corrected visual acuity (BCVA), spherical equivalent, stereopsis, and time interval between cataract surgeries. RESULTS: The mean age was 71.26 ± 10.84 (range, 25–90) years, mean interval between surgery in each eye was 118.46 ± 183.50 (range, 17–1,018) days, and mean postoperative diopter difference was 1.16 ± 0.53 (range, 0.00–2.75) diopters. After bilateral cataract surgery, 22 patients (31.43%) experienced a change in eye dominance, whereas 48 patients (68.57%) experienced no change. There were no differences in the time interval between cataract surgeries, preoperative UCDVA and UCNVA, pre- and postoperative BCVA, or stereopsis in either group. Patients who experienced a change in eye dominance showed smaller differences between preoperative and postoperative spherical equivalent, compared with patients who experienced no change in eye dominance (t-test, p < 0.05). CONCLUSIONS: Twenty-two (31.43%) patients whose nondominant eyes were targeted for near vision showed altered eye dominance after conventional monovision cataract surgery. Eye dominance shows greater plasticity in patients with smaller differences between preoperative and postoperative spherical equivalent.

Macular thickness and retinal nerve fiber thickness analysis in ocular dominance / Espessura macular e fibra nervosa da retina análise de espessura no domínio ocular

Abstract Objective: To compare macular and peripapillary retinal nerve fiber layer thicknesses of dominant eye and non-dominant eye using optical coherence tomography (OCT). Methods: 104 eyes of 52 healthy young adults were included. Ophthalmological examinations; including measuring refraction, best corrected visual acuity, intraocular pressure (IOP) measurement, slit-lamb biomicroscopy, dilated fundus examination, measuring of central macular thickness (CMT), and peripapillary retinal nerve fiber layer (PRNFL) thickness were performed on each subject. Hole-in-the-card test was used to detect the ocular dominance. Results: There were 25 females (48%) and 27 males (52%) in the study. Eight participants had left eye dominance (15%), forty-four participants had right eye dominance (85%). Mean CMT was 192.5µm in dominant group and 191.9 µm in non-dominant group. There was no statistically significant difference between dominant eye group and non-dominant eye group in either macular thickness or peripapillary retinal nerve fiber layer thickness. Conclusions: No difference between macular and peripapillary retinal nerve fiber layer thicknesses were detected in dominant and non-dominant groups. Further evaluation is needed.

Resumo Objetivo: Comparar as espessuras da camada de fibras nervosas da retina macular e peripapilar do olho dominante e não dominante usando a tomografia de coerência óptica (OCT). Métodos: 104 olhos de 52 adultos jovens saudáveis foram incluídos. Exames oftalmológicos; incluindo medidas de refração, melhor acuidade visual corrigida, medição da pressão intraocular (PIO), biomicroscopia de fenda-cordeiro, exame do fundo dilatado, medição da espessura macular central (CMT) e espessura da camada de fibras nervosas da retina peripapilar (PRNFL) foram realizadas em cada sujeito. O teste Hole-in-the-card foi usado para detectar a dominância ocular. Resultados: houve 25 mulheres (48%) e 27 homens (52%) no estudo. Oito participantes tinham deixado a dominância do olho (15%), quarenta e quatro participantes tinham dominância do olho direito (85%). A CMT média foi de 192,5 µm no grupo dominante e 191,9 µm no grupo não dominante. Não houve diferença estatisticamente significativa entre o grupo dominante de olho e o grupo de olho não dominante tanto na espessura macular quanto na espessura da camada de fibras nervosas da retina peripapilar. Conclusões: Não houve diferença entre as espessuras das camadas de fibras nervosas da retina macular e peripapilar nos grupos dominante e não dominante. Mais avaliações são necessárias.

The Angle Kappa in Dominant and Non-Dominant Eye

PURPOSE: To evaluate differences between dominant and non-dominant eyes by analyzing angle kappa in dominant and non-dominant eyes. METHODS: Fifty-seven subjects who had best corrected visual acuity 20/20 in the better-seeing eye and no underlying ocular disease were recruited. Ocular dominance was determined using the hole-in-the-card test. Corneal topography, refractive error, intraocular pressure (IOP), and axial length were evaluated in both eyes. RESULTS: On corneal topography examination, the angle kappa and white-to-white measurements were significantly smaller in the dominant eye than the non-dominant eye (p = 0.013 and p = 0.045, respectively). However, no significant differences in sim K's' astigmatism (p = 0.210), central corneal thickness (p = 0.533), and anterior chamber depth (p = 0.216) were observed. In addition, cylindrical powers of the subjects measured by autorefraction (AR) were significantly lower in the dominant eye (p = 0.026); however no differences in spherical equivalent measured by AR (p = 0.061), IOP measured using pneumonic tonometer (p = 0.536), or axial length measured using laser biometry (p = 0.093) were observed. CONCLUSIONS: In this study, we found the angle kappa a new factor in determining the dominant and non-dominant eye. Difference in axial length and spherical equivalent between dominant and non-dominant eye may be associated with the difference in angle kappa.

Comparação do teste de fenilefrina a 10 (por cento) com o teste do levantamento manual da pálpebra ptótica em pacientes portadores de ptose palpebral involucional / Comparison of the effect of 10 (por cento) phenylephrine instillation and manual elevation in patients with involutional blepharoptosis

O objetivo primário do presente estudo foi quantificar e comparar as alterações do posicionamento da pálpebra superior nos olhos testados e nos olhos contralaterais de portadores de ptose palpebral senil submetidos à instilação de colírio de fenilefrina a 10% em um dos olhos e ao teste do levantamento manual da pálpebra ptótica. Como objetivo secundário, verificar a influência da dominância ocular, da intensidade e da uni ou bilateralidade da ptose nas respostas palpebrais frente aos dois testes. Métodos: Estudo clínico prospectivo transversal, que avaliou o efeito da ação tópica do colírio de fenilefrina a 10% e da manobra de levantamento manual da pálpebra no posicionamento palpebral de indivíduos portadores de ptose palpebral involucional unilateral ou bilateral. Os pacientes foram filmados antes e 5, 10 e 15 minutos após a instilação do colírio. A distância margem reflexo (DMR1) foi medida com a utilização do software Image J e os resultados foram analisados com o modelo linear de efeitos mistos. Resultados: Na pesquisa foram incluídos 70 indivíduos entre 44-86 anos, 64 destes do sexo feminino (91.43%), divididos em três grupos: indivíduos com ptose unilateral; com ptose bilateral e controles. O olho submetido à instilação do colírio de fenilefrina apresentou aumento da DMR1 nos primeiros 10 minutos: de 1,33±0,66 mm para 2,06±0,89 mm (grupo ptose unilateral), de 1,26 ± 0.63 mm para 2,29±0,86 mm (grupo ptose bilateral) e de 3,12 ± 0,68 mm para 4,06 ± 0,92 mm (grupo controle). A DMR1 diminuiu nos olhos contralaterais dos pacientes portadores de ptose, mais significativamente após a instilação do colírio de fenilefrina: teste de fenilefrina vs. levantamento manual da pálpebra = 18.9% vs. 17.2% de redução no grupo com ptose unilateral, e 13.6% vs. 10.7% de redução no grupo com ptose bilateral. Os fatores: dominância ocular, uni ou bilateralidade da ptose e a sua intensidade não influenciaram na resposta aos testes. Conclusões: O aumento da DMR1 ocorreu nos...

Purpose: The primary aim of this study is quantify and compare the effect of 10% phenylephrine instillation and manual elevation (ME) on the upper eyelid position of the tested eye and the contralateral eye in patients with involutional blepharoptosis (IB). The secondary objective is to correlate the eye dominance, severity and laterality of ptosis with eyelid position changes after these two tests. Methods: This is a prospective transversal study conducted in involutional ptosis patients, submitted to two tests followed by observation of the effect on the contralateral eyelid: 1) ME of the more ptotic eyelid, and 2) instillation of two drops of 10% PE (phenylephrine test) in the more ptotic eye. The patients were filmed before and 5, 10 and 15 minutes after instillation. The upper eyelid margin reflex distance (MRD1) was measured using the software Image J, and the results were analyzed with the linear mixed-effects model. Results: The study included 70 patients aged 44- 86 years, 64 of whom were female (91.43%), divided into three groups: subjects with unilateral ptosis, subjects with bilateral ptosis and controls. The eye submitted to instillation with 10% PE displayed significant elevation during the first 10 min: from 1.33±0.66mm to 2.06 ± 0.89mm (unilateral group), from 1.26 ± 0.63mm to 2.29 ± 0.86mm (bilateral group) and from 3.12 ± 0.68mm to 4.06±0.92mm (control group). MRD1 decreased in the contralateral eye in IB patients, significantly more so after the phenylephrine test: PE vs. ME = 18.9% vs. 17.2% reduction in the unilateral group, and 13.6% vs. 10.7% reduction in the bilateral group. The outcome was not influenced by IB severity and the concurrence of IB and eye dominance. Conclusion: MRD1 elevation in tested eyes in all groups. Both Manual elevation and phenylephrine tests affected the contralateral upper eyelid, but the response was significantly better with the latter.

Comparison of OCT Parameters between the Dominant and Nondominant Eye

PURPOSE: To evaluate the anatomical difference between the dominant and nondominant eyes in healthy, young adults by measuring macular, peripapillary retinal nerve fiber layer (PRNFL), and macular ganglion cell layer (MGCL) thicknesses. METHODS: Two hundred healthy adults were recruited and assessed for ocular dominance using 'a hole in the card test'. PRNFL, macular and MGCL thicknesses of both eyes were measured using spectral domain optical coherence tomography (OCT). RESULTS: There were no statistically significant differences for average thicknesses of MGCL in each of the six areas between the dominant and nondominant eyes. No difference was observed between temporal, inferior, average PRNFL thickness and macular thickness in dominant and nondominant eyes. CONCLUSIONS: There was no intraocular anatomical difference between the dominant and nondominant eyes in healthy, young adults.

Relationship among Dominant Eye & Hand and Deviated Eye under General Anesthesia

PURPOSE: To evaluate the association between ocular dominance, hand dominance and eye deviation in orthophoric and strabismus patients under general anesthesia during surgery. METHODS: The subjects were divided into 2 groups. Group 1 was composed of 38 patients who underwent strabismus surgery and group 2 was composed of 107 patients who underwent non-strabismus surgery under general anesthesia. Best corrected visual acuity (BCVA), dominant hand and fixating eye were obtained before surgery, and ocular dominance was assessed using the hole-in-the-card test. Under general anesthesia, we took a digital photo of both eyes, and the deviating eye was determined. RESULTS: Under general anesthesia, the deviated eye showed no statistically significant correlation to the dominant eye and dominant hand in group I, respectively (p = 0.61, 0.74, respectively). In group II, there was no correlation between the deviated eye and the dominant eye (p = 0.65). The deviated eye also showed no correlation to the dominant hand in group II (p = 0.61). CONCLUSIONS: There was no correlation between the dominant and deviated eye under general anesthesia in the strabismus surgery group and the non-strabismus surgery group. Also, there was no correlation between the dominant hand and the deviated eye in patients under general anesthesia in the 2 groups.

Retinal Nerve Fiber Layer Thickness and Optic Disc Parameters in Dominant Compared with Non-Dominant Eyes

PURPOSE: To investigate the comparison of retinal nerve fiber layer (RNFL) thickness and optic disc parameters measured by optical coherence tomography (Cirrus HD-OCT(R)) in dominant and non-dominant eyes. METHODS: Seventy-one subjects without underlying ocular disease were recruited for the present study. Ocular dominance was determined using the hole-in-the-card test. Comprehensive standardized eye examinations were performed. Scans of the optic disc and RNFL were performed using OCT. RESULTS: The mean intraocular pressure (IOP) of the dominant eye was higher than its counterpart (p = 0.025). No significant differences were observed in uncorrected visual acuity, refractive error and axial length between dominant and non-dominant eyes (p = 0.235, 0.180, 0.850). No RNFL and optic disc features were identified in the dominant from non-dominant eyes. CONCLUSIONS: Although dominant eyes tended to have higher IOP than non-dominant eyes, no consistent ocular structural differences between dominant and non-dominant eyes with the use of OCT were found.

Developmental Switch of the Serotonergic Role in the Induction of Synaptic Long-term Potentiation in the Rat Visual Cortex

Synaptic long-term potentiation (LTP) and long-term depression (LTD) have been studied as mechanisms of ocular dominance plasticity in the rat visual cortex. Serotonin (5-hydroxytryptamine, 5-HT) inhibits the induction of LTP and LTD during the critical period of the rat visual cortex (postnatal 3~5 weeks). However, in adult rats, the increase in 5-HT level in the brain by the administration of the selective serotonin reuptake inhibitor (SSRI) fluoxetine reinstates ocular dominance plasticity and LTP in the visual cortex. Here, we investigated the effect of 5-HT on the induction of LTP in the visual cortex obtained from 3- to 10-week-old rats. Field potentials in layer 2/3, evoked by the stimulation of underlying layer 4, was potentiated by theta-burst stimulation (TBS) in 3- and 5-week-old rats, then declined to the baseline level with aging to 10 weeks. Whereas 5-HT inhibited the induction of LTP in 5-week-old rats, it reinstated the induction of N-methyl-D-aspartate receptor (NMDA)-dependent LTP in 8- and 10-week-old rats. Moreover, the selective SSRI citalopram reinstated LTP. The potentiating effect of 5-HT at 8 weeks of age was mediated by the activation of 5-HT2 receptors, but not by the activation of either 5-HT1A or 5-HT3 receptors. These results suggested that the effect of 5-HT on the induction of LTP switches from inhibitory in young rats to facilitatory in adult rats.

Effect of Dominant Versus Non-dominant Vision in Postural Control

OBJECTIVE: To assess the effect of dominant and non-dominant vision in controlling posture in quiet stance. METHOD: Twenty-five healthy elderly subjects aged over 60 years old and twenty-five young subjects aged under 30 years old were assessed by computerized dynamic posturography. Postural stability was measured in two conditions; dominant eye open and non-dominant eye open. We used the sensory organization test (SOT) for evaluating sensory impairment. A SOT assessed the subject's ability to use and integrate somatosensory input, vision, and vestibular cues effectively to maintain balance. The SOT was conducted 3 times, and the average value of the 3 trials was used for data analysis. Equilibrium scores reflected the subject's anteroposterior sway. The highest possible score was 100, which indicated that the subject did not sway at all, and a score of 0 indicated a fall from the footplate. Determination of ocular dominance was performed by a hole-in-the card test. RESULTS: For the twenty-five young subjects in this study, equilibrium score in two conditions did not differ. However, for elderly subjects over 60 years, the equilibrium score in dominant vision was higher than in nondominant vision (p<0.05). CONCLUSION: In young subjects, there were no significant differences in postural control between dominant vision and non-dominant vision. However, in elderly subjects, postural control in non-dominant vision was significantly impaired. Therefore, the evaluation of a dominant eye should be considered in rehabilitation programs for elderly people.

Effects of Serotonin on the Induction of Long-term Depression in the Rat Visual Cortex

Long-term potentiation (LTP) and long-term depression (LTD) have both been studied as mechanisms of ocular dominance plasticity in the rat visual cortex. In a previous study, we suggested that a developmental increase in serotonin [5-hydroxytryptamine (5-HT)] might be involved in the decline of LTP, since 5-HT inhibited its induction. In the present study, to further understand the role of 5-HT in a developmental decrease in plasticity, we investigated the effect of 5-HT on the induction of LTD in the pathway from layer 4 to layer 2/3. LTD was inhibited by 5-HT (10 micrometer) in 5-week-old rats. The inhibitory effect was mediated by activation of 5-HT2 receptors. Since 5-HT also regulates the development of visual cortical circuits, we also investigated the role of 5-HT on the development of inhibition. The development of inhibition was retarded by chronic (2 weeks) depletion of endogenous 5-HT in 5-week-old rats, in which LTD was reinstated. These results suggest that 5-HT regulates the induction of LTD directly via activation of 5-HT2 receptors and indirectly by regulating cortical development. Thus, the present study provides significant insight into the roles of 5-HT on the development of visual cortical circuits and on the age-dependent decline of long-term synaptic plasticity.

Monovisión con lente intraocular monofocal en pacientes présbitas / Monovision with monofocal intraocular lens in prebyopic patients

OBJETIVO: Describir los resultados refractivos obtenidos mediante la cirugía del cristalino en pacientes présbitas hipermétropes y miopes con monovisión. MÉTODOS: Se realizó un estudio descriptivo, prospectivo, longitudinal con 21 pacientes, 13 miopes y 8 hipermétropes sometidos a cirugía del cristalino para corregir la presbicia con el método de la monovisión en el Servicio de Microcirugía del Instituto Cubano de Oftalmología Ramón Pando Ferrer entre febrero del 2009 y febrero del 2010. Las variables utilizadas fueron: agudeza visual con corrección preoperatoria y posoperatoria y sin ella, lejos y cerca, y equivalentes esféricos. Se utilizó la media y desviación estándar para presentar la información. RESULTADOS: En el preoperatorio la agudeza visual promedio mejoraba de un valor de 0,7 y 0,9 corregida para miopes e hipermétropes respectivamente a 0,88 y 0,94 de agudeza visual binocular sin corrección para estos mismos grupos en el posoperatorio, corrigiendo de esta manera equivalentes esféricos promedios de -8,27 D y +6,26 D en cada grupo. La agudeza visual cercana promedio para ambos grupos fue de Jeager 2 y los equivalentes esféricos promedios alcanzados para visi¾n lejana fueron de -0,32 D para miopes y +0,26 D para hipermétropes; en visión cercana, o sea, en el ojo no dominante es de -1,6 D para el primer grupo y -1,3 D para el segundo grupo. CONCLUSIONES: Se halló mejoría indudable de la agudeza visual sin corrección tanto para la visión lejana como para la cercana después de la cirugía. Los equivalentes esféricos fueron ampliamente modificados para ambos grupos tanto en los ojos dominantes como en los no dominantes para facilitar el resultado visual en ambas distancias. Los resultados obtenidos corroboran que la monovisión produce un mayor beneficio en la visión cercana que el perjuicio que provoca en la visión lejana lo que la hace muy exitosa para cierto grupo de pacientes

OBJECTIVES: To describe the refractive results achieved in presbyopic patients, both hyperopic and myopic, with monovision METHODS: A prospective, longitudinal and descriptive study was carried out in 21 patients, 13 myopic and 8 hyperopic, who underwent lens surgery to correct presbyopia based on the monovision procedure at the Microsurgery Service of the Ramón Pando Ferrer Cuban Institute of Ophthalmology from February 2009 to February 2010. The variables were pre and postoperative visual acuity with/without correction, both near and distant, and spheral equivalents. Mean and standard deviation values were used to present all variables. RESULTS: It was found that average visual acuity with correction improved from 0,7 and 0,9 in myopic and hyperopic patients respectively to 0,88 and 0,94 of binocular visual acuity without correction in the postoperative phase, thus correcting their average spheral equivalents of 8,27 diopters (D) and +6,26 D in each group. The average visual acuity for near vision for both groups was Jeager (J) 2 and the average spheral equivalents reached for distant vision were -0,32 D for myopic and +0,26 D for hyperopic patients. For near vision, i.e. in the non- dominant eye, the spheral equivalent values were 1,6 D for the first group and 1,3 D for the second group. CONCLUSIONS: After surgery there was an undoubted improvement in visual acuity without correction, in near as well as in distant vision. Spherical equivalents were widely modified for both groups in both the dominant and the non-dominant eye, improving vision at both distances. The achieved results corroborate that the benefits brought about by monovision in near vision are more important than the damages it causes in distant vision, making it very successful for certain groups of patients

Correlation Analysis of Ocular Dominance and Levator Palpebrae Superioris Muscle Function

PURPOSE: Most of the bilateral structures in our body are not perfectly balanced, such that one side is preferred than the other or it has physiological superiority. Eyes also have an imbalance; the eye with sensory and motional superiority compared to the other is called dominant eye. Authors of this study focused on analyzing the correlation between the dominant eye and levator palpebrae superioris muscle. METHODS: The subject of this study was 42 patients with no ptosis and with no past history of blepharoplasty. Hand dominance was identified through questionnaire and dominant eye was identified by hole-in-the-card dominance test (Dolman's test) in all patients. The function of levator palpebrae superioris muscle was measured by MLD (marginal limbal distance). During the measuring procedure, frontalis muscle was not inhibited to avoid the eyelid skin hooding. RESULTS: Out of 42 patients, 27 patients(64.3%) were right ocular dominant, 15 patients(35.7%) were left ocular dominant, 36 patients(85.7%) were right hand dominant and 4 patients(9.5%) were left hand dominant. Out of 27 right ocular dominant patients, right MLD was larger than the left in 26 patients(96.3%). It was larger in average of 0.47mm(p<0.001) in 27 right ocular dominant patients. Also, left MLD was larger than the right in 11 patients (73.3%) out of 15 left ocular dominant patients. It was larger in average of 0.57mm(p=0.003) in 27 left ocular dominant patients. MLD on the side of the dominant eye was larger in average of 0.50mm(p<0.001) than the MLD of non-dominant eye side. Right MLD was larger than the left in average of 0.28mm(p=0.010) in right hand dominant patients, and left MLD was larger than the right in average of 1.15mm(p=0.025) in left hand dominant patients. CONCLUSION: The function of levator palpebrae muscle differs in right and left, and the difference correlates with the dominant eye. Also, the function of levator palpebrae muscle is stronger in the dominant eye. We were able to present statistical evidence regarding the difference of the function in right and left levator palpebrae muscle. This may be a factor worth consideration in terms of balancing the eyes during the blepharoplasty.

The Refractive Errors of Dominant and Non-dominant Eyes

PURPOSE: To evaluate differences between dominant and non-dominant eyes through analyzing refractive factors in determination of the dominant eye. METHODS: Sixty-two subjects without underlying ocular disease were recruited. Ocular dominance was determined using the hole-in-the-card test. Uncorrected visual acuity, refractive error, and intraocular pressure (IOP) were checked in both eyes. RESULTS: Mean uncorrected visual acuity of the dominant and non-dominant eye were 0.41 and 0.39, respectively. The number of patients whose uncorrected visual acuity of the dominant eye was superior to the non-dominant eye was 18(29%), and inferior to the non-dominant eye was 18(29%). Mean refractive power in the dominant eye was -3.2 diopter and -3.43 diopter degrees in the non-dominant eye, therefore no difference in degrees of myopia between the groups (P=0.282) was observed. The number of patients whose dominant eye had a greater degree of myopia than the non-dominant eye was 24(39%) and the patients with a lower degree of myopia in the dominant eye was 32(52%). Astigmatism of the dominant eye was lower than the non-dominant eye in 35(56%) of the patients, thus a significant relationship was shown between astigmatism and the dominant eye (P=0.0014). The mean IOP of the dominant eye was 15.4 mmHg and the non-dominant eye was 15.7 mmHg, showing no significant difference between eyes. CONCLUSIONS: The dominant eye showed a lower degree of astigmatism than the non-dominant eye. The previous belief that myopia is more progressed in the dominant eye than the non-dominant eye because of excessive accommodative use of the dominant eye requires further study.

Ocular Dominance Determined by Near Point of Convergence Test in Intermittent Exotropia

This study was designed to validate the usefulness of the near point of convergence(NPC)test in determination of dominant & non-domnant eyes in intermittent exotropia patients. We performed NPC test in 36 intermittent exotrpic patients, and then, determined the non-dominant eye which deviated outward beyond the NPC. The dominant eyes determined by the NPC were compared to those that were determined by amblyopia, sensory fusion and photophobia. Best corrected visual acuity was used to divide patients into two groups : 26 patients without amblyopia, and 10 with amblyopia. Among the amblyopia group, if the eyes with better visual acuity were taken as dominant eyes, then eight(80%)cases were identical with the NPC test and two(20%)cases were different. Ten patients had sensory anomaly, and among then, nine(90%)cases were identical with the NPC test and one(10%)case was different. Twenty six(64%)patients had photophobia in one eye and all(100%)cases were identical with the NPC test. In intermittent exotropia, determination of dominant eye by the NPC test showed high coincidence with other tests. Therefore, we suggest that the NPC test is an easy and accurate method in determining either the dominant or non-dominant eye for surgery.

The Relationship of Dominant Eye, Dominant Hand, and Deviated Eye in Strabismus

We studied the relationship of deviated eye with dominant eye, dominant hand and visual acuity in 109 horizontal strabismic patients. Control group of 109 normal subjects without strabismus or specific ocular diseases were also examined. Right ocular dominance in normal subjects was noted in 66.1%. Strabismic patients showed ocular dominance of nondeviated eye in 78.5%. The dominance of right hand in normal subjects were noted in 89.0% and those were 82.6% in strabismic patients. Better visual acuity of right eye were noted in 40.4% of normal subjects, and 28.4% in left eye. Equal visual acuity between two eyes were 31.2% of the subjects. Strabismic patients showed better visual acuity in 70.9% of nondevia ted eye. Based on these results, the correlation of nondeviated eye with dominant eye, and better visual acuity were statistically significant(p0.05).